Causes of folic acid deficiency anemia

Folic acid is one of the B vitamins. It helps produce red blood cells. Low levels of folic acid (also called folate) in the body decrease production of red blood cells and cause folic acid deficiency anemia.

Causes of folic acid deficiency anemia include:

  • Not eating enough foods that contain folic acid.
    • The homeless, people with substance abuse problems, the elderly, and low-income families are among those who may have low levels of folic acid because of poor diet.
    • Vegan diets may not include enough folic acid.
    • People with the eating disorder anorexia nervosa severely limit how much they eat, including those foods that contain folic acid.
  • Having an increased need for folic acid, as might happen with:
    • Pregnancy. Pregnant women need additional folic acid to protect their babies from birth defects, especially defects in the spine, the brain, or the bone and skin (neural tube defects).
    • Blood disorders called hemolytic anemias, such as sickle cell anemia, that use up the body's supply of folic acid.
    • Diseases that cause rapid cell growth, such as leukemia or psoriasis.
    • An increased rate of the chemical processes that take place in the body (metabolism), as might happen with an overactive thyroid (hyperthyroidism). This uses up the body's store of folic acid faster than it is absorbed.
  • Not absorbing or retaining folic acid.
    • Drinking too much alcohol interferes with the absorption of folic acid in the body, because alcohol increases the amount of folic acid that is lost through the urine.
    • People who have severe kidney problems may need to have a procedure that cleans the blood (hemodialysis), which increases folic acid loss.
    • Uncommon disorders in the intestines, such as celiac (nontropical) sprue, can interfere with the body's ability to absorb folic acid.
  • Taking certain medications, including:
    • Methotrexate, which is used for rheumatoid arthritis and some cancers. It is common in the U.S. for doctors to prescribe folic acid along with methotrexate to prevent folic acid deficiency.
    • Some antibiotics if used for a long time, including Coptin (part of Bactrim and Septra) and pentamidine.
    • Some medicines to prevent seizures, such as phenytoin, primidone, carbamezapine, and phenobarbital.
    • Sulfasalazine, used for treating inflammatory bowel disease and rheumatoid arthritis.
    • Oral birth control medicines.
    • Triamterene (part of triamterene/HCTZ, which is also known as Maxzide), used to treat some people with high blood pressure.

Last Updated: December 23, 2008

Author: Caroline Rea, RN, BS, MS

Medical Review: Anne C. Poinier, MD - Internal Medicine & Brian Leber, MDCM, FRCPC - Hematology

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